Regional Director for Europe to Member States of the WHO European Region: Influenza A(H1N1)
8 May
Dear Colleague,
Since the detection of the influenza A(H1N1) virus in Mexico and the United States of America, 24 countries have reported a total of 2371 confirmed cases worldwide as of 8 May. Several WHO Member States are conducting investigations of this outbreak, and WHO continues to monitor and compile surveillance data and case reports. The current level of pandemic alert remains at phase 5. This means a pandemic may be imminent, but nobody knows how severe it could be, when it could happen or how long it could last.
While a significant number of countries are reporting new cases, community transmission is not occurring elsewhere in the world in the same way as in Canada, Mexico and the United States.
The number of cases in the European Region has been too few to give a full picture of the virus and its potential impact, but there is now early information on the H1N1 virus' behaviour and disease patterns in North America, where most of the cases have occurred. The virus appears to be easily transmitted from person to person and community transmission is widespread.
The spectrum of the disease seems to be very broad, from asymptomatic to fatal cases. In all countries, most reported cases have experienced a mild influenza-like illness and some have not developed fever. Severe illness and fatal cases have been reported in Mexico and the United States, however, especially in people who are at risk for complications of seasonal influenza, such as the very young, pregnant women and people with underlying medical conditions, but also in some healthy young adults.
At present, the virus is susceptible to oseltamivir (Tamiflu) and zanamivir (Relenza). There is no convincing laboratory or clinical evidence that vaccination against normal seasonal influenza confers protection against the new H1N1 virus, and this requires more study.
This situation is expected to evolve over time and bears careful watching. Although illness to date has mainly been mild, WHO expects the number of cases and the geographic spread of the virus to increase. A pandemic could affect a large part of the world's population, with some cases of severe illness requiring hospital treatment and some deaths. Thus, it is essential to be prepared and focus on measures that minimize the impact of the disease's spread.
WHO expects the situation to evolve over a period of weeks, months or years. Past pandemics have turned from mild to severe over a two-year period. WHO advises countries to focus action and resources on preparedness for the medical services that may be needed in the coming months, rather than only on short-term containment efforts.
WHO recommends that countries expand their current efforts to include assessments of their immediate and medium-term needs and to plan for the provision of necessary resources for treatment and care, including equipment, drugs and personnel; increased surveillance; laboratory diagnostics; and communication with the public.
Now is the time when WHO can work with countries to prepare for a potential pandemic. The Regional Office for Europe is making intense efforts to assist Member States in assessing and responding to their needs in all these areas. For example, WHO has arranged the first deployment of antiviral drugs from its stockpile to countries in the Region: a total of over 200 000 courses. Priority was given to the countries in most need, taking into consideration national manufacturing and procurement capacity. As necessary, other countries will be supported through the Regional Office stockpile.
We continue to work with its regional and global partners, industry and national ministries support all countries of the European Region to meet this global challenge.
Yours sincerely,
Marc Danzon, M.D.
Regional Director
WHO Regional Office for Europe
